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Pathfinder GPs confront Lansley over health bill changes

Health secretary Andrew Lansley was challenged by GP pathfinders on the Government's changes to the health bill this morning, as commissioning enthusiasts expressed scepticism at plans to place consultants from outside local health providers on consortium boards.

The controversial move announced yesterday means that all commisisoning consortia - now rebranded 'clinical commissioning groups' - will have to accept one nurse and one hospital consultant who are not from a local health provider onto their board.

Mr Lansley told delegates at the Commissioning Live conference in London that the move had been made to appease hospital consultants who were concerned about having a voice.

Dr Roger Pinnock, chair of the Ashford Locality Commissioning Group, asked the health secretary: 'We're in East Kent - we're effectively a peninsula. We have sea on three sides of us. Where on earth is this consultant going to come from?'.

Mr Lansley said it was imperative that conflicts of interest were avoided, but said the problem could resolved by appointing specialists doing tertiary work, hospital doctors who had recently retired, or consultants who lived in the local area but worked elsewhere.

He explained: 'A number of your medical colleagues specifically wanted to feel that the place where commissoning decisions are being taken, there was a specialist voice. What we have to do is avoid conflicts of interest. We have to find somebody who doesn't in your view contravene those conflicts of interest.'

'Clearly if you were to appoint the medical director or the nursing director of the local healthcare trust that wouldn't work. It may be perfectly reasonable that if senior clinicians in local healthcare providers can meet that criteria, that will be open to you to go to the NHS Commisisoning Board and say, they don't constitue a conflict of interest because of the nature of the services they provide.'

'Many of your hospital consultant colleagues felt they were being excluded... so what we need to do is demonstrate that that is far from the case.'

But Dr Chris Trzcinski, chairman of North and West Leicestershire consortia, was unconvinced by Mr Lansley's answer.

He said: 'I don't think you've really given us an answer that we can work with. People that want to be involved are the local consultants. You will end up with people who aren't directly involved in the local health service. I think you really need to rethink that one more carefully.'

Mr Lansley responded: 'There is no way in which you actually identify one person in any practical sense who can be representative of the range of specialities. That is not the intention. But it was put strongly that your consultant colleagues want to be involved.'

He added: 'But I don't think this is the answer to how specialists and the range of professionals are involved in commissining. Being involved in commissioning is about these other bodies where you sit and work together that are distinct from your responsbility as a commissioning organisation.'